|
 


 

‡ @

± complete or incomplete tear in the
supporting ligaments surrounding joints.

‡ @

± overstretching injury to a muscle or
tendon.
‡ @

± commonly result from wrenching or
twisting motion

‡ @

± typically result from excessively
vigorous movement in understretched
and overstretched muscles and tendons
‡ @
 ‡ @

‡  and discomfort ‡ Pain
‡ Edema ‡ Edema
‡ Decreased joint ‡ Ecchymoses
motion and function
‡ Feeling of joint
looseness
ë. Administer prescribed medication
2. Provide nursing care for the client who
sustain sprain.
3. Provide nursing care for a client who
suffer muscle or tendon strain.
4. Provide additional teaching
 
of a bone from its
normal articulation with a joint
‡ May be congenital
‡ May result from trauma or disease
of surrounding joint tissue
‡ 
‡ Visible disruption of joint contour
‡ Edema
‡ Ecchymoses
‡ Impaired joint mobility
‡ Change in extremity length and in axis
of dislocated bones
ë. Administer prescribed medication
2. Prevent from further injury
3. Assist physician in reducing displaced
parts as necessary
4. Provide teaching
 Remember

‡ Rest
‡ Ice
‡ Compress
‡ Elevate
‡ Disruption in the continuity of bone as a
result of trauma or various disease process

‡ Highest incidence in males 15-24 years and

in elderly persons, women aged 65 years
and older
2
 
2 
 
2
 
 
2  
 
 6ractures
Complete fracture- Closed fracture ± does
involves a break not produce a break in
across the entire cross the skin.
section of the bone Open fracture ±
and is frequently presence of break in
displaced from normal the skin.
position Greenstick ± bone
Incomplete fracture ± bends w/out fracturing
break occurs through across completely,
the only part of the cortex on the covade
cross section of the side remain intact
bone.
 Other fractures
Transverse ± fracture Crush ± occurs in
that is straight across cancellous bone as
the bone, caused by a result of a
force applied to the compression force.
site. Burst ± occurs in a
short bone resulting
Spiral/ oblique ± from strong direct
fracture twisting pressure.
around the shaft of the Compression ±
bone, caused by fracture which the
violence forced bone has been
through the limb. compressed
Impacted- fracture Pathologic ± fracture
where the fragment through an area of
are driven into one diseased bone.
 Other fractures
Avulsion ± pulling Compound ± fracture
away of a fragmet of with a surface or
bone by a ligament or open wound. Include
tendon & its more than one break
attachment. in the bone.
Epiphyseal ± fracture Comminuted ±
through the epiphysis fracture with more
than one fragments
2 
2 

  


2

2

2 



2

2


‡ xcessive motion on site
‡ oft tissue edema
‡
armth over injured area
‡ aralysis distal to injury resulting from
nerve entrapment
‡ igns of shock related to severe tissue
injury
 Fracture care
‡ splinting of fracture
‡ preservation of body alignment
‡ elevation of body part to limit edema
‡ application of cold packs
‡ observe for changes in color, sensation,
or temperature of injured part
‡ observe for signs of shock
‡ Fat embolism
‡ Compartment syndrome
‡ Nonunion
‡ Arterial damage
‡ Infection
‡ Hemorrhage/ Shock
Fat emboli
- serious, potentially life-threatening
complication

 
estlessness
mental status changes
tachycardia
tachypnea
hypotension
Dyspnea
etechial rash over the upper chest and neck.
°ompartment syndrome
- increased pressure within a limited anatomic
space compromising circulation, viability, and
function of tissues within that space.

‡  
‡ increased pain and swelling
‡ pain with passive motion
‡ inability to move joints
‡ loss of sensation
‡ pulselessness
=nfection and osteomyelitis
- caused by the interruption of the
integrity of the skin; the infection invades
bone tissue.

‡  
± fever
± pain
± erythema in the affected area
± tachycardia
± elevated
° count
wvascular necrosis- interruption in the blood
supply to the bony tissue, which results in the
death of the bone.
‡  
‡ pain
‡ decreased sensation

ulmonary mboli- caused by immobility

precipitated by a fracture
‡  
‡ restlessness and apprehension
‡ Dyspnea
‡ Diaphoresis
‡ w changes
 Äreatment
‡ plinting- immobilization of the
affected part to prevent soft tissue from
being damaged by bony parts

‡ °asting- provides rigid immobilization

of affected body part for support and
stability
 Äreatment
‡ =nternal fiation- use of metal screws,
plates, nails and pins to stabilize
reduced fractures
‡ Äraction
‡ eduction- restoration of the fracture
fragments into anatomic alignment and
rotation.
±ursing care planimplementation for
clients with Fracture
romote healing and prevent complications
‡ diet high protein, iron, vitamins (tissue
repair), moderate carbohydrates
(prevent weight gain)
‡ increase fluid intake
 ±ursing care planimplementation for
clients with Fracture

‡ assess for complications of immobility

(pneumonia, constipation, decubitus
ulcers, osteoporosis)
‡ assess casted etremity for presence of
foul odor, drainage, paleness or
blueness, change in temperature,
pulselessness, tingling, numbness
 ±ursing care planimplementation for
clients with Fracture

revent injury or trauma

‡ avoidance of high-risk activities (sky
diving, high impact sports, rollerblading)
‡ avoidance of safety hazards (throw rugs,
untreated vision problems)
‡ regular eercise
 ±ursing care planimplementation for
clients with Fracture

‡ rovide care related to ambulation with

crutches

‡ rovide safety measures related to

possible complications following fracture
 ±ursing Management
‡ Administer prescribed medication
‡ Provide care during transfer of the patient
- immobilized the fractured extremity
- support the affected side.
‡ Provide client and family teaching
- explain prescribed activity restriction
- Teach the proper use of assistive
devices.
- Provide additional teaching
 Stages of Bone Healing
‡ HEMATOMA AND IN6 AMMATION
‡ ANGIOGENESIS AND CARTI AGE
6ORMATION
‡ CARTI AGE CA CI6ICATION
‡ CARTI AGE REMOVA
‡ BONE 6ORMATION
‡ REMODE ING
‡ Callus formation: Ú to 4 weeks
‡ Ossification begins within 2 to Ú week up to Ú to 4
months
‡ Progress should be monitored by serial x-rays ± reveals
complete bone union
‡ An orthopedic treatment that involves
placing tension on a limb, bone or muscle
group using variety of weight and pulley
systems
1. Decreased muscle spasm
2. Reduce, align, and immobilize
fractures
3. Correct or prevent deformity
4. Increase space between joint
surfaces.
‡ traight or unning traction
± involve straight pulling force
in one plane.
‡ alanced suspension traction
± involves exertion of a pull
while the limb is supported by
hammock or splint
‡ kin traction
± involves weight applied and held to the
skin with a Velcro splint.

‡ keletal traction
± involves weight applied and attached to
metal/pin inserted into bone
uck¶s tension
Äraction ± femur & hip
fracture
Overhead ± fracture of
humerus
Head halter ± cervical
spine affection
Pelvic girdle ± lumbo-
sacral affection,
herniated nucleus
pulposus
Dunlop¶s Äraction ± fractured elbow and
humerus
`alo pelvic ± scoliosis
Halo femoral ± severe scoliosis
 Bryant¶s traction ±
femoral fracture,
Hip injuries among
kids below 3 years
old
‡ uttocks are slightly
elevated and clear off the
bed.

Boot leg ± hip and

femoral affection
Ninety degrees ±
fracture of the
femur
Stove- in ±chest
± severe chest
injury with
multiple rib
fracture
Hammock suspension ± pelvic affection
 kin Äraction
‡ To control muscle spasm
‡ To immobilize an area before surgery
 @   


1. Uses wires, pins, or
tongs placed through
the bones
2. MOST frequently
used in treating
fractures of femur,
humerus, tibia &
cervical spine.
 ±

± 

2 

  

2     
  
  
      
2   

 
2
  

 

  


 

2 ± 
 



 
1. Prevent complications of immobility
2. Promote skin integrity
3. Inspect for signs of skin breakdown,
irritation or infection
4. Provide client teaching
5. Promote self-care within traction
limitation
uck¶s etension
‡ simplest form and provides for straight
pull on the affected etremity
‡ relieve muscle spasm
‡ immobilize a limb temporarily
‡ `eel is supported off bed to prevent
pressure on heel, weight hangs free of
the bed, and foot is well away from
footboard of bed, and parallel to the
bed.
ussel traction
- permits the patient to move freely in the
bed - permits fleion of the knee joint.
‡ used in the treatment of intertrochanteric
fracture of the femur when surgery is
contraindicated

‡ `ip is slightly fleed. illows may be

used under lower leg to provide support
and keep the heel free of the bed.
ussell¶s Äraction
 ±ursing =ntervention of atient¶s
with Äraction
[ Monitor color, motion, and sensation of
the affected etremity
‡ Monitor the insertion sites for redness,
swelling, or drainage
‡ atient education
‡ Maintaining the traction
‡ kin care
‡ wssist in toileting
‡ w. Open reduction ± involves reduction
and alignment of fractures through surgical
opening

‡ . =nternal Fiation ± involves

stabilization of reduced fracture with
screws, or pins
‡ °. one graft ± involves placement of bone
tissue for healing, stabilization, or
replacement

‡ D. wrthroplasty ± involves joint repair

through small arthroscope
‡ . wrthrodesis ± involves immobilization
of joint through fusion.

‡ F. Joint replacement ± involve

replacement of joint surface with metal or
plastic materials
 Äypes of Joint eplacement
‡ 1. Äotal hip replacement ± involves
replacement of the ball and socket of a
severely damaged hip joint

‡ 2. Äotal knee replacement ± involves

replacement to tibial, femoral, and patellar
joints.
‡ . Äendon transfer ± involves movement
of tendon insertion

‡ `. Äenotomy ± involves cutting tendons

‡ =. Fasciotomy ± involves removal of

muscle fascia, relieving constriction
‡ J. Osteotomy ± involves alignment of bone
by removal of a wedge

‡ urpose of Orthopedic urgery

± Reconstruct diseased or injured
musculoskeletal structure
 w  M±Ä
‡ 1. reoperative assessment
± Elicit the client¶s medical history
± Identify current medication and condition
± Assess nutritional and hydration status
± Assess skin integrity
‡ 2. ostoperative wssessment
‡ Assess the cardiovascular
,respiratory , fluid and electrolyte.
Nutritional status
‡ Assess neurovascular status
‡ Assess for joint dislocation
‡ Assess for infection
‡ Assess for thromboembolism
‡ Assess and maintain safety and
effectiveness of orthopedic apparatus
 Äotal `ip eplacement

‡ a plastic surgery that involves removal of

the head of the femur followed by
placement of a prosthetic implant
 igns and symptoms necessitating
urgery
‡ evere chronic pain
‡ Loss of joint mobility
‡ cessive joint destruction
‡ =nfection in the joint
‡ °ontractures
 ±ursing Management
‡ Äeach client how to use crutches
‡ Äeach client mechanics of transferring.
‡ Discuss importance of turning and
positioning post-op.
‡ lace affected leg in an abducted position
and straight alignment following surgery
‡ revent hip fleion of more than 90
degrees.
 ±ursing Management
‡ wpply support stockings
‡ wdvise client to avoid eternalinternal rotation
of affected etremity for 6 months to 1 year
after surgery
‡ =nstruct client to avoid ecessive bending,
heavy lifting, jogging, jumping
‡ ncourage intake of foods rich in Vitamin °,
protein, and iron.
‡ wdminister prescribed medications.
 °omplications
‡ =nfection
‡ `emorrhage
‡ Ährombophlebitis
‡ ulmonary embolism
‡ rosthesis dislocation
‡ rosthesis loosening
‡ An implant
procedure in which
tibial, femoral and
patellar joint
surfaces are
replaced.
‡ Assess the 

 
 of the leg
‡   knee in extension with a firm
compression dressing and an adjustable splint
or long leg cast
‡  on pillows
‡ Apply 
 to control edema and bleeding
‡ Encourage 
  of the foot every hour
when patient is awake
‡ 
: ëst 8 hrs. = 200 ml
‡ After 48 hrs = less than 25 ml
 Ä

2





wmputation of a Lower tremity
‡ surgical removal of a lower limb or part of the
limb.
- 10% of patients eperience uncomfortable
sensations- phantom limb pain.
- hantom limb pain described as a cramp or
uncomfortable sensation
- disappears with time
- the pain is a real sensation and should not be
dismissed as illusionary.
ë |   

         

 

 ! 

     

 

" ±
 !
!

# $ 
  
 

°omplications of wmputation
± =nfection

±
ound necrosis

± hantom limb pain

± °ontractures

± kin breakdown
‡ Monitor vital signs M until stable, then q
2 hours for ëst 24 hours, then q 4 hours.

‡ Keep the stump   for ëst 
 to

prevent edema

‡ After 
    elevate with pillows

BUT rather elevate the foot of the bed.





!
‡ Place patient in a
position for , four
times per day. (especially "#") after 24-48 hrs to
stretch the muscles and prevent flexion contracture of
hip
‡ Have patient lie in a   position with the knee in
extension (especially $#").
‡ Encourage to do active ROM of extremity to strengthen
muscles and inhibit contractures.
‡ Maintain on low-Fowler¶s or flat position after AKA
‡ In prone position, place a pillow under the abdomen
and stump and keep the legs close together to prevent
abduction

‡ Support stump with pillow for first 24 hours; place

rolled bath blanket along outer aspect to prevent
outward rotation.

‡ Encourage exercises to prevent thromboembolism

‡ Encourage patient to ambulate using correct crutch-

walking techniques
‡ °


‡ °
‡ % 

°

 
  
‡A disease characterized by
›
›
› 

  

and
?
   of the
bone tissue that compromise bone
quality.

‡Bones become 
 and

prone to fracture.
 °



  


v@ &! most patients are

Y

 of osteoporosis until
the first bone 
  occurs.

It is more common in   than

males: in women,
 

drops drastically during menopause and

this accelerates bone loss.
Ä

 


 





 


' (
)


' 
) *
+' 
 



' °
 
 
' ,*

 
-' ,



.' @/



/
) 
)







'
' 
 


/


)


 Aging

°",°  @0

(

BONE RESORPTION BONE FORMATION

ãoss of BONE MASS

( 
)
M


!

‡ Occurrence of osteoporosis
‡ Family history
‡ Previous Fractures
‡ Dietary consumption of calcium
‡ Exercise patterns
‡ Onset of menopause
‡ Use of corticosteroids
‡ Alcohol, smoking & caffeine intake
BACK PAIN
SHORTENED STATURE &
CONSTIPATION
SPINAã DEFORMITY

FRACTURE IMPAIRED MOBIãITY BREATHING PROBãEMS

ë. Reviewing and evaluating a
patient's:
‡ )
 
,
‡ )  &
‡  ) 

2. Measuring $)

ë. Balance diet rich in °",°12 & 3"2 
2. Regular weight-bearing 40°@@
3. Hormone replacement therapy (HRT) with
@0
 50
@0 
4. Other medications:
‡ " 

‡ °

  



   
 

   %     

  
 # 

 Sufficient intake of



Adequate *6


.
Maintain a  ) ) .

() to prevent falls and fractures.

To maintain bone mass, postmenopausal women
may need adequate 

 

 )
according to a doctor's advice.
  ,

‡ Result from trauma or secondary
infection.
‡ Blood-borne (hematogenic)
osteomyelitis is common children
‡ Chronic illness
‡ ãong term corticosteroid therapy
 ° 
 2
‡ ãocalized bone pain
‡ Tenderness, heat, and edema
‡ Guarding of the affected area
‡ Restricted movement
‡ Systemic symptom
‡ Purulent drainage
‡ malaise
 Lab D Findings
‡ WBC count reveals leukocytosis
‡ ESR is elevated
‡ Blood cultures identifies the causative agent
(Staph. Aureus)
‡ Radiograph and bone scan
 ±ursing Management
1. Administer prescribed medication
2. Protect the affected extremity from further
injury and pain
3. Promote healing and tissue growth
4. Prepare client for surgical treatment
5. Provide additional teaching
6. May apply warm, wet soaks 20 min
several times a day
-a slowly progressive, degenerative joint disease
characterized by variable changes in weight-bearing
joint.
-Also known as Degenerative Joint Disease/
Hyperthropic Arthritis
‡ Associated with
‡ Obesity
‡ Aging (>50yr)
‡ Trauma
‡ Genetic predisposition
‡ Congenital abnormalities
‡ Pain and muscle spasm, aggravated by use
relieved by rest
‡ ãimited motion
‡ Joint grating with movement
‡ Flexion contractures
‡ Joint tenderness
‡ Presence of Heberden¶s nodes or Bouchard¶s
nodes
‡ Weight loss
‡ Cold intolerance
‡ Radiographs may reveal a narrowing of
joint space
1. Administer prescribed medication
2. Provide nonpharmacologic comfort
measures
3. osition the client to prevent flexion
deformity
4.Plan activities that promote optimal function
and independence
5. Refer to physical and occupational therapy
6. Prepare the client fro surgical treatment as
indicated
7. Provide referrals
 Medication
wspirin
‡ inhibits cyclooygenase enzyme, it
diminishes the formation of
prostaglandins
‡ anti-inflammatory, analgesic, antipyretic
action
‡ inhibit platelet aggregation in cardiac
disorders
wdverse effects
‡ = pigastric distress, nausea, and
vomiting
‡ lood inhibition of platelet aggregation
and a prolonged bleeding time
‡ espiratory =n toic doses, can cause
respiratory depression
‡ `ypersensitivity
‡ eye¶s syndrome wcute encephalopathy
following a viral illness and is
characterized pathologically by cerebral
edema and fatty changes in the liver
Äoicity (mild or severe)
‡ Mild salicylism nausea, vomiting, marked
hyperventilation, headache, mental
confusion, dizziness, and tinnitus
‡ evere salicylism restlessness, delirium,
hallucinations, convulsions, coma,
respiratory and metabolic acidosis and death
from respiratory failure.
 =buprofen
‡ anti-inflammatory, analgesic,and
antipyretic acitivity
‡ use for chronic treatment of rheumatoid
and osteoarthritis
‡ less = effects than aspirin
‡ reversible inhibitors of the
cyclooygenases and inhibit the synthesis
of prostaglandins
wdverse effects
‡ = dyspepsia to bleeding
‡ °±  headache, tinnitus and dizziness
 =ndomethacin
‡ anti-inflammatory, analgesic and
antipyretic acitivity
‡ inhibits cyclooygenase enzyme
‡ more potent than aspirin as an anti-
inflammatory agent
wdverse effects
‡ dose-related
‡ = nausea, vomiting, anoreia, diarrhea
and abdominal pain
‡ °±  frontal headache, dizziness, vertigo,
light-headedness, and mental confusion
‡ `ypersensitivity reaction
 ±ursing Management
romote comfort reduce pain, spasms,
inflammation, swelling

‡ medications as prescribed.
‡ `eat to reduce muscle spasm
‡ °old to reduce swelling and pain
‡ revent contractures eercise, bed rest
on firm mattress, splints to maintain
proper alignment

‡ osition elevate etremity to reduce

swelling

‡ romote independence

  



 




 
 








 |     
 
 
 

&

  


 
 |  %  

 (  ' 
   
'   
  
 (
 
  

 

'  '  

 heumatoid arthritis

‡ chronic systemic inflammatory disease

‡ destruction of connective tissue and
synovial membrane within the joints
‡ weakens and leads to dislocation of the
joint and permanent deformity
isk Factors
‡ eposure to infectious agents
‡ fatigue
‡ stress
 Diagnostic tests
‡ levated  

‡ Mild leukocytosis

‡ wnemia

‡ ositive F
 igns and ymptoms
‡ inflammation, tenderness, and stiffness of
the joints
‡ moderate to severe pain and morning
stiffness lasting longer than Ú0 minutes
‡ joint deformities, muscle atrophy, and
decreased range of motion
‡ spongy, soft feeling in the joints
‡ low grade fever, fatigue and weakness
 igns and ymptoms
‡ anoreia, weight loss, and anemia
‡ elevated  , and positive F
± ±onreactive 0-Ú9 = ml (°)
±
eakly reactive 40-79 = ml (°)
± eactive greater than 80 = ml (°)
‡ X-ray showing joint deterioration
heumatoid wrthritis
heumatoid wrthritis
 Medication
‡ alicylates (acetylsalicylic acid )

‡ ± w=Ds

‡ °orticosteroids- anti-inflammatory

‡ old salts
 old salts
‡ slow-acting, anti-inflammatory agents

‡ old sodium thiomalate, wurothioglucose,

wuranofin

‡ - these drugs cannot repair eisting damage,

rather they can only prevent further injury

‡ - use in the treatment of w that does not

respond to salicylates or other ± w=D
therapy
‡ wdverse effects
‡ dermatitis of the skin or of the mucous
membranes
‡ proteinuria and nephrosis
‡ old salts should be avoided in patients
suffering from hepatic or renal disease,
pregnancy.
‡ erious Äoicity Dimercaprol
 Äreatment

‡ `ot and °old packs to affected joints

‡ urgical rocedures synovectomy,

arthrotomy, arthrodesis, arthroplasty
 ±ursing Management

revent or correct deformities

‡ bed rest
‡ daily OM eercises
‡ heat andor pain medication
‡ increase oral fluid intake at least 1500 mL
to prevent renal calculi
A metabolic disease marked by
urate crystal deposits in joints
throughout the body.
- ãinked to a genetic deficit
in purine metabolism
- Age (>50yr)

- Higher incidence in men

 igns and ymptoms
‡ etreme pain
‡ swelling
‡ erythema of the involved joints
‡ fever
‡ tophi
‡ sudden attacks, usually at night
‡ Pain, joint swelling and inflammation
‡ Intolerance to the weight of bed linen
over the affected joint
‡ Pruritus or skin ulceration
‡ Signs of renal involvement
‡ ë. Arthrocentesis reveals urate crystal in
synovial fluid
‡ 2. Serum uric acid level is increased
‡ 3. Radiographs may show joint damage
in advanced disease.
 Äreatment
‡ wllopurinol
- a purine analog
- reduces the production of uric acid by
competitively inhibiting uric acid
biosynthesis which are catalyzed by
anthine oidase.
 wllopurinol
- ffective in the treatment of primary
hyperuricemia of gout and
hyperuricemia secondary to other
conditions (malignancies).

‡ wdverse effects hypersensitivity

reactions, nausea and diarrhea
 °olchicine
‡ ffective for acute attacks of gouty arthritis pain

‡ educes inflammation in the joint.

‡ Does not prevent the progression of gout but have

a suppressive, prophylactic effect reducing the
frequency of acute attacks and relieves pain.

‡ wnti-inflammatory activity alleviating pain within

12 hours
 °olchicine
‡ wdverse effects: nausea, vomiting,
abdominal pain, diarrhea,
agranulocytosis, aplastic anemia, alopecia
ë. Administer prescribed medication
2. Promote measures to prevent
exacerbations.
3. Provide measures to promote comfort
and reduce pain
4. Provide client teaching
 Caring for
Patient with
 %7

‡ Osteomalacia
involves 


of the bones caused
by a u
 


 or
problems with the
metabolism of this
vitamin.
‡ In children, the
condition is
called


and is usually
caused by a
u
 


 .
‡ In adult, the condition
is usually caused by:
1. Inadequate dietary
intake of vitamin D
2. Inadequate exposure
to sunlight (ultraviolet
radiation)
3. Malabsorption of
vitamin D
‡ ¢ u :
   u
 or acquired disorders
of vitamin D metabolism
 u 

 and acidosis ,
 ¢ u   associated with
low dietary intake or kidney
disease
4. Side effects of  u
 used
to treat seizures .
‡ Risk factors are related to
the causes.
± In the elderly, there is an
increased risk for those who
tend to  
u and
who avoid milk because of

    

‡ The incidence is 
people.
‡ diffuse § 
 , especially in the hips
‡ muscle 
 
‡ symptoms associated with low calcium
 §  around the mouth & of
extremities
2. Carpopedal 

  of legs
4. Waddling or limping GAIT
  
 in height/ Spinal Deformities
(i.e. KYPHOSIS)
‡ In
 
, symptoms of


include:
ƒ 
 sitting, crawling, and walking; 
when walking; and the development of
*  or 
6 '
1. Bone biopsy: (

  u
2. Bone X-ray or CT scan of lumbosacral spine
shows u  

.
3. Studies of the vertebrae: (+)  
!
4. Low serum 
 level
5. Low serum 
 &  
levels
6. Elevated "# (Alkaline Phosphatase)
1. Adequate dietary
intake of dairy
products that are
fortified with


2. Adequate exposure
of the body to
 
‡ ¢
   
of vitamin D ,
calcium, and
phosphorus
‡ Large doses of Vitamin D
with   
may be indicated in
people with intestinal
malabsorption .
‡ Monitoring of blood levels
of    and

 may be indicated
with some underlying
conditions.
‡ 
  or surgery to
correct deformities
‡ 

 of the nucleus of the disk into the
fibrous ring of the disk with subsequent nerve
compression
‡ May occur in any portion of the vertebral column
‡ @5@) 
ë. Pain
2. Sensory changes
3. ãoss of reflex
4. Muscle weakness
 ' °


[ Pain/ Stiffness ± head, neck & upper extremities
[ Paresthesia, numbness
[ Weakness
' ,

[ ,*
  radiating to the buttocks and leg
[ Postural deformity of the spine
[ (+) Straight-ãeg Raise test
[ Weakness & Asymmetric reflexes
[ Sensory loss


" 
! Perform
  assessments of 




8
  to determine progression of condition
wlleviating pain

1. Anti-inflammatory drugs, muscle relaxants, and

narcotic analgesics
2. Use of bed boards under the mattress
Ú. ed rest ± supine or low fowler¶s or side lying
position with slight knee flexion and pillows
between knees.
4. Moist heat application
5. elaation techniques
@5@) !
‡ Abnormal lateral deviation of spine
‡ Unleveled shoulder
‡ Asymmetric waistline
‡ Prominent scapula

° 
!
‡ Related to respiratory problems due
to decreased lung expansion as a
result of severe curvature of the
spine
 ±ursing =mplementation
1. Monitor progression of the curvature
2. repare the child and parents for the use of a
brace if prescribed
± usually worn from 16 to 2Ú hours a day
± inspect the skin for signs of redness or breakdown
± keep the skin clean and dry, avoiding lotions and
powders
± advise the child to wear soft nonirritating clothing
under the brace
 ±ursing =mplementation
repare the child and parents for surgery if prescribed.

ostoperative
‡ maintain proper alignment; avoid twisting movements

‡ logroll the child when turning, to maintain alignment

‡ instruct in activity restrictions

‡ instruct the child to roll from a side-lying position to a

sitting position, and assist with ambulation
 aget's Disease of one
‡ Localized rapid bone turnover, most commonly
affecting the skull, femur, tibia, pelvic bones
and vertebrae
‡ rimary bone resorption followed by bone
formation
‡ Diseased bone is highly vascularized but
structurally weak
‡ More common in the adult (>50 yo)
‡ Male > female
 °linical Manifestations
‡ bowing of femur and tibia
‡ enlargement of the skull
‡ cranial nerve compression
‡ respiration distress
‡ pain
‡ high cardiac output
failure
 Diagnostics
‡ X-rays
‡ erum alkaline phosphatase- elevated
‡ erum calcium- elevated
‡ one scan
 ±ursing Management
‡ revent pathological fractures
‡ °ontrol pain
‡ wdminister drugs as prescribed
 one Äumors
Osteosarcoma
‡ Most common primary bone tumor
‡ Occurs between 10-25 years of age, with Paget's
disease and exposure to radiation
‡ Exhibits a moth-eaten pattern of bone destruction.
‡ Most common sites: metaphysis of long bones
especially the distal femur, proximal tibia and
proximal humerus
Osteosarcoma
 °linical Manifestations
‡ local signs ± pain ( dull, aching and
intermittent in nature), swelling,
limitation of motion
‡ systemic symptoms malaise, anoreia,
and weight loss
 Diagnostics
‡ iopsy- confirms the diagnosis
‡ X-ray
‡ M=
‡ one can
 Medical Management

‡ adiation
‡ °hemotherapy
‡ urgical management
± amputation
± limb salvage procedures
 ±ursing Management
‡ romote understanding of the disease
process and treatment regimen
‡ romote pain relief
‡ revent pathologic fracture.
‡ romote coping skills and self esteem
‡ wssess for potential complications
(infection, complications of immobility).
 ±ursing Management
‡ rovide care for client with amputation
‡ Observe for signs of bleeding
‡ levate stump on pillow for 24-40 hrs
‡ Äurn patient to prone position for short
time first post-op day then 2-Ú daily
 ±ursing Management
‡ ncourage eercise as soon as possible
(1st or 2nd post-op day)
‡ Dangle and transfer patient to wheelchair
and back within 1st or 2nd day post-op;
crutch walking started as soon as patient
feels sufficiently strong
‡ wpply lanolin to dry skin
 Other Musculoskeletal Disorders

Dysplasia of the `ip

‡ condition in which the head of the femur
is improperly seated in the acetabulum,
or hip socket, of the pelvis.
‡ °ongenital or develop after birth
 wssessment
±eonates laity of the ligaments around the hip,
which allows the femoral head to be displaced
from the acetabulum upon manipulation.

=mplementation
‡ plinting of the hips with avlik harness to
maintain fleion and abduction and eternal
rotation (neonatal period)
 wssessment
=nfants beyond the newborn period
a. wsymmetry of the gluteal and thigh skinfolds
when the child is placed prone and the legs are
etended against the eamining table.
b. Limited range of motion in the affected hip.
c. wsymmetric abduction of the affected hip
when the child is placed supine with the knees
and hips fleed.
d. apparent short femur on the affected side
(alleazzi sign, wllis sign)
pica °ast
 CARPA TUNNE SYNDROME:
‡ It occurs when the median nerve at the wrist is
compressed
‡ ASSESSMENT:
‡ Pain
‡ Numbness
‡ Paresthesia
‡ Thumb, 1st & 2nd fingers affected=Tinel Sign(
tingling sensation when inner wrist is
percussed)
 Management:

‡ Wrist splinting
‡ Avoid repetitive wrist movement
‡ Carpal canal cortisone injection
‡ Surgical release of tendon sheat